Why is air medical transport still killing us?

Headlines such as 'crew members killed in air medical crash' are not new news

By Art HsiehEMS1 Editorial Advisor

Since September last year, there have been four crashes of medical helicopters, resulting in 12 deaths. The latest came last month in Brownsville, Tenn., where all three crew members died.

The National Transportation Safety Board issued its preliminary report into the crash Monday but is yet to rule on the cause.

Headlines such as 'crew members killed in air medical crash' are not new news — which is concerning. Several columnists and authors have commented on this issue, from Bryan Bledsoe and Paul Mazurek on EMS1 to New York Times reporter Christine Negroni.

The NTSB issued a report in 2006 that identified safety weaknesses in air medical operations and provided recommendations to the risk of crashing. That report was based on a study of 55 crashes that occurred from 2002 to 2005, resulting in 54 fatalities.

Between 2007 and 2008, 35 deaths occurred during nine crashes. Subsequent meetings between medical helicopter industry representatives and the Federal Aviation Administration have focused on trying to improve the safety and reliability of air medical transport.

In a 2009 survey on how medical helicopter providers responded to the FAA "best practices" recommendations, inspectors noted the following adoption rates:

Decision-making skills and risk assessment programs – 94 percent

Response to FAA guidance on Loss of Control (LOC) and Controlled Flight Into Terrain (CFIT) avoidance – 89 percent

Integration of operation control center – 89 percent

Installation of Flight Data Recorders and devices that can re-create a flight – 11 percent

Terrain Awareness and Warning Systems (TAWS) equipage – 41 percent

Use of radar altimeters – 89 percent

Yet helicopters are still crashing.

The number of medical helicopters and the number of flight hours logged have grown exponentially. Critics have pointed to issues surrounding helicopter transport, including:

The medical necessity of using helicopters for emergencies

The staffing model of having one pilot aboard

The lack of federal regulatory oversight

Flying under inherently very dangerous conditions

The potential pressure felt by operators to remain financially solvent.

There is a growing amount of attention being paid to this area of emergency medical transport, and debate.

Yet we're still crashing, with tragic results.

The National EMS Memorial Service has honored EMS personnel who died in the line of duty since 1993. While noting that the service does not track all fatalities in the United States, it is sobering to note that 215 of its 538 inductees died from air medical crashes. That's almost 40 percent.

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